Healthcare Provider Details

I. General information

NPI: 1912134453
Provider Name (Legal Business Name): AMY G FIEDLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE STE A501
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

400 PARNASSUS AVE STE A501
SAN FRANCISCO CA
94143-2202
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1606
  • Fax: 415-353-1312
Mailing address:
  • Phone: 415-353-1606
  • Fax: 415-353-1312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberA178750
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMED-PHYS-LIC-104842
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL-240116
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: